Show simple item record

A multifaceted quality improvement project improves intraoperative redosing of surgical antimicrobial prophylaxis during pediatric surgery

dc.contributor.authorColletti, Ashley A.
dc.contributor.authorWang, Ellen
dc.contributor.authorMarquez, Juan L.
dc.contributor.authorSchwenk, Hayden T.
dc.contributor.authorYeverino, Calida
dc.contributor.authorSharek, Paul J.
dc.contributor.authorCaruso, Thomas J.
dc.date.accessioned2019-08-09T17:14:18Z
dc.date.availableWITHHELD_12_MONTHS
dc.date.available2019-08-09T17:14:18Z
dc.date.issued2019-07
dc.identifier.citationColletti, Ashley A.; Wang, Ellen; Marquez, Juan L.; Schwenk, Hayden T.; Yeverino, Calida; Sharek, Paul J.; Caruso, Thomas J. (2019). "A multifaceted quality improvement project improves intraoperative redosing of surgical antimicrobial prophylaxis during pediatric surgery." Pediatric Anesthesia 29(7): 705-711.
dc.identifier.issn1155-5645
dc.identifier.issn1460-9592
dc.identifier.urihttps://hdl.handle.net/2027.42/150557
dc.description.abstractBackgroundAccurate intraoperative antibiotic redosing contributes to prevention of surgical site infections in pediatric patients. Ensuring compliance with evolving national guidelines of weight‐based, intraoperative redosing of antibiotics is challenging to pediatric anesthesiologists.AimsOur primary aim was to increase compliance of antibiotic redoses at the appropriate time and appropriate weight‐based dose to 70%. Secondary aims included a subset analysis of time compliance and dose compliance individually, and compliance based on order entry method of the first dose (verbal or electronic).MethodsAt a freestanding, academic pediatric hospital, we reviewed surgical cases between May 1, 2014, and October 31, 2017 requiring antibiotic redoses. After an institutional change in cefazolin dosing in May 2015, phased interventions to improve compliance included electronic countermeasures to display previous and next dose timing, an alert 5 minutes prior to next dose, and weight‐based dose recommendation (September 2015). Physical countermeasures include badge cards, posting of guidelines, and updates to housestaff manual (September 2015). Statistical process control charts were used to assess overall antibiotic redose compliance, time compliance, and dose compliance. The chi‐square test was used to analyze group differences.ResultsA total of 3015 antibiotic redoses were administered during 2341 operative cases between May 1, 2014, and October 31, 2017. Mean monthly compliance with redosing was 4.3% (May 2014‐April 2015) and 73% (November 2015‐October 2017) (P < 0.001). Dose‐only compliance increased from 76% to 89% (P < 0.001), and time‐only compliance increased from 4.9% to 82% (P < 0.001). After implementation of countermeasures, electronic order entry compared with verbal order was associated with higher dose compliance, 90% vs 86% (P = 0.015).ConclusionThis quality improvement project, utilizing electronic and physical interventions, was effective in improving overall prophylactic antibiotic redosing compliance in accordance with institutional redosing guidelines.
dc.publisherWiley Periodicals, Inc.
dc.publisherThe Mack Printing Company
dc.subject.othersurgical wound infection
dc.subject.otherrisk factors
dc.subject.otherantibacterial agents
dc.subject.otherantibiotic prophylaxis
dc.subject.otheranti‐infective agents
dc.subject.othercefazolin
dc.titleA multifaceted quality improvement project improves intraoperative redosing of surgical antimicrobial prophylaxis during pediatric surgery
dc.typeArticle
dc.rights.robotsIndexNoFollow
dc.subject.hlbsecondlevelSurgery and Anesthesiology
dc.subject.hlbsecondlevelPediatrics
dc.subject.hlbtoplevelHealth Sciences
dc.description.peerreviewedPeer Reviewed
dc.description.bitstreamurlhttps://deepblue.lib.umich.edu/bitstream/2027.42/150557/1/pan13651_am.pdf
dc.description.bitstreamurlhttps://deepblue.lib.umich.edu/bitstream/2027.42/150557/2/pan13651.pdf
dc.identifier.doi10.1111/pan.13651
dc.identifier.sourcePediatric Anesthesia
dc.identifier.citedreferenceBerríos‐Torres SI, Umscheid CA, Bratzler DW, et al. Centers for disease control and prevention guideline for the prevention of surgical site infection, 2017. JAMA Surg. 2017; 152: 784 ‐ 791.
dc.identifier.citedreferenceDellinger EP, Gross PA, Barrett TL, et al. Quality standard for antimicrobial prophylaxis in surgical procedures. Infect Control Hosp Epidemiol. 1994; 15: 182 ‐ 188.
dc.identifier.citedreferenceThe Western Electric Company. Statistical Quality Control Handbook. Easton, PA: The Mack Printing Company; 1958.
dc.identifier.citedreferenceCaruso TJ, Wang E, Schwenk HT, et al. A quality improvement initiative to optimize dosing of surgical antimicrobial prophylaxis. Pediatr Anesth. 2017; 27: 702 ‐ 710.
dc.identifier.citedreferenceKnox MC, Edye M. Educational antimicrobial stewardship intervention ineffective in changing surgical prophylactic antibiotic prescribing. Surg Infect (Larchmt). 2016; 17: 224 ‐ 228.
dc.identifier.citedreferenceKasatpibal N, Whitney JD, Dellinger EP, et al. Failure to Redose Antibiotic Prophylaxis in Long Surgery Increases Risk of Surgical Site Infection. Surg Infect. 2017; 18: 474 ‐ 484
dc.identifier.citedreferenceLeong G, Wilson J, Charlett A. Duration of operation as a risk factor for surgical site infection: comparison of English and US data. J Hosp Infection. 2006; 63: 255 ‐ 262.
dc.identifier.citedreferenceBratzler DW, Dellinger EP, Olsen KM, et al. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm. 2013; 70: 195 ‐ 283.
dc.identifier.citedreferenceKhoshbin A, So JP, Aleem IS, Stephens D, Matlow AG, Wright JG. Antibiotic prophylaxis to prevent surgical site infections in children: a prospective cohort study. Ann Surg. 2015; 262: 397 ‐ 402.
dc.identifier.citedreferenceBratzler DW, Hunt DR. The surgical infection prevention and surgical care improvement projects: national initiatives to improve outcomes for patients having surgery. Clin Infect Dis. 2006; 43: 322 ‐ 330.
dc.identifier.citedreferenceCaruso TJ, Wang EY, Colletti AA, Sharek PJ. Intraoperative antibiotic redosing compliance and the extended postoperative recovery period: often overlooked areas that may reduce surgical site infections. Pediatr Anesth. 2019; 29: 290 ‐ 291.
dc.identifier.citedreferenceMorse J, Blackburn L, Hannam JA, Voss L, Anderson BJ. Compliance with perioperative prophylaxis guidelines and the use of novel outcome measures. Pediatr Anesth. 2018; 28: 686 ‐ 693.
dc.identifier.citedreferenceSomme S, Bronsert M, Morrato E, Ziegler M. Frequency and variety of inpatient pediatric surgical procedures in the United States. Pediatrics. 2013; 132: e1466 ‐ 1472.
dc.identifier.citedreferenceKurth CD. Introducing quality improvement. Pediatr Anesth. 2013; 23 ( 7 ): 569 – 570.
dc.owningcollnameInterdisciplinary and Peer-Reviewed


Files in this item

Show simple item record

Remediation of Harmful Language

The University of Michigan Library aims to describe library materials in a way that respects the people and communities who create, use, and are represented in our collections. Report harmful or offensive language in catalog records, finding aids, or elsewhere in our collections anonymously through our metadata feedback form. More information at Remediation of Harmful Language.

Accessibility

If you are unable to use this file in its current format, please select the Contact Us link and we can modify it to make it more accessible to you.